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The Greenhouse Project

Author: Rosalyn Neranartkomol M.Sc. in Gerontology from USC

6th year medical student

Origin/affiliation: Medical University of Silesia in Poland


The Greenhouse Project model of nursing home care was introduced to me while I was studying gerontology; the innovative model was found by Dr. William H. Thomas. It shuns the industrial complex long term care model for a smaller more personalized approach with its core principles being real home, empowered staff, and meaningful life. Subsequently, after seventeen years of operation and expansion it has proven its effectiveness during this trying time by demonstrating lower levels of infections and deaths from COVID-19 in its occupants compared to traditional nursing home care.

The approach focuses on being small in scale with occupants having their own rooms and bathrooms while also having shared outdoor spaces, living rooms, dining rooms which all come together to create a home-like environment. Discovering this model made an impact on me as it is an example of an alternative to the current long term care solution as I would like to see a more dignified approach to our eldercare as well as a more satisfied working life for staff.

A Greenhouse home also do not have the traditional staffing model as one of the revolutionizing aspects of the project is the transformation of care structure to try to create more independence in residents and workers. Certified nursing assistances renamed to shahbazim (singular: Shahbaz) and they are under the jurisdiction of a guide, a coach to the shahbazim, they are tasked with overseeing all the non-clinical running of the house whereas the nurses are other medical care team members oversee clinical decisions. Each Greenhouse home have different nurses and shahbazim relationships but what research has shown is that when nurses and shabazims work in parallel or in an integrated manner there is a higher quality of care to residents and more work satisfaction in staff.

As for residents who need memory care, the Greenhouse project also has its own methodology to this population called the Best Life approach which is based on the core principles of focusing on the person living with dementia (PLWD)’s retained abilities, their rights in taking risks, their rights for rehabilitation, their abilities to befriend others and befriend pets, as well as trying to advocate for or expand their choices. Continued implementation of these principles will one day inform us of its efficacy, however, to see changes being made in memory care is already astounding.

Overall, I am thrilled to see what the Greenhouse Project model has brought to the long term and sub-acute care continuum, and I hope for its continued success. Nevertheless, I also hope that there will also be new players in this field in the future to build upon each new discovery and experiment with more approaches to give residents, caregivers, and care providers increased options. If you know of any other approaches in your country, please feel free to share in the comments.


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